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What Is a Subretinal Hemorrhage?

A subretinal hemorrhage is bleeding that collects under the retina, often between the neurosensory retina and the retinal pigment epithelium. When the bleed involves the macula, it can reduce vision quickly and cause distortion. The most common triggers involve abnormal blood vessels, such as choroidal neovascularization in age-related macular degeneration. Because blood is toxic to retinal cells over time, timely evaluation matters.

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What Is a Subretinal Hemorrhage?

A subretinal hemorrhage is bleeding that collects under the retina, often between the neurosensory retina and the retinal pigment epithelium. When the bleed involves the macula, it can reduce vision quickly and cause distortion. The most common triggers involve abnormal blood vessels, such as choroidal neovascularization in age-related macular degeneration. Because blood is toxic to retinal cells over time, timely evaluation matters.

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What Causes a Subretinal Hemorrhage?

Age-related macular degeneration with choroidal neovascularization is a frequent cause of subretinal bleeding near the macula. Polypoidal choroidal vasculopathy can also bleed under the retina and can create recurrent hemorrhages. Trauma can rupture delicate layers and lead to subretinal blood, sometimes with a choroidal rupture pattern. Other causes include retinal arterial macroaneurysm, pathologic myopia with neovascularization, and inflammatory choroiditis that triggers new vessels. Blood thinners can worsen the size of a bleed, even when the root cause is vascular.

What Are Subretinal Hemorrhage Symptoms?

Many people notice sudden blurred central vision, especially when the macula is involved. Straight lines can look wavy, and reading can become difficult because letters look distorted or missing. A dark spot in the center of vision can appear, sometimes described as a blot or shadow. Colors can look duller on the affected side, and contrast can drop in dim light. Sudden, severe vision loss needs urgent assessment because rapid treatment can protect macular function.

How Is a Subretinal Hemorrhage Diagnosed?

A dilated retinal exam can show fresh blood under the retina and can reveal signs of the underlying cause, such as macular degeneration changes. Optical coherence tomography (OCT) helps confirm the location of blood and shows whether fluid or a neovascular membrane is also present. Fluorescein angiography and indocyanine green angiography can help identify abnormal vessels when the view is limited by blood. Ultrasound can help when the hemorrhage is dense or when other pathology is suspected. Diagnosis also includes reviewing risk factors such as age, high myopia, trauma history, and anticoagulant use.

How Is a Subretinal Hemorrhage Treated?

Treatment depends on the size, location, and cause of the hemorrhage, plus how quickly symptoms started. If choroidal neovascularization is the driver, anti-VEGF injections are commonly used to reduce ongoing leakage and bleeding risk. For thicker submacular hemorrhages, a retina specialist can use pneumatic displacement with an intraocular gas bubble, sometimes paired with tissue plasminogen activator (tPA), to move blood away from the fovea. Vitrectomy-based approaches are considered in select severe cases, especially when blood is extensive or combined with vitreous hemorrhage. Follow-up is important because recurrence can happen if the underlying neovascular process stays active.

Frequently Asked Questions About a Subretinal Hemorrhage

Is a Subretinal Hemorrhage an Emergency?

It can be, especially when the bleed involves the macula or vision drops suddenly. Blood under the macula can damage photoreceptors, so early retina evaluation is helpful. Urgency also rises when symptoms start within days or the hemorrhage is large. A same-day or next-day exam is a safe choice for new central vision loss.

Can a Subretinal Hemorrhage Heal on Its Own?

Small hemorrhages can resorb over time, but vision recovery depends on the cause and the macular involvement. Even when blood clears, scarring or ongoing abnormal vessels can limit vision. Treatment often targets the root cause to prevent rebleeding. A retina specialist can explain prognosis based on imaging.

What Is the Most Common Cause of Subretinal Hemorrhage?

Macular neovascularization related to age-related macular degeneration is one of the most common causes in older adults. Polypoidal choroidal vasculopathy is another important cause in many populations. Trauma becomes more likely in younger patients, especially with blunt injury. Imaging helps confirm the specific source.

References

Management of Submacular Hemorrhage. EyeWiki. https://eyewiki.org/Management_of_Submacular_Hemorrhage. Date Accessed February 4, 2026.

Managing Submacular Hemorrhage. American Academy of Ophthalmology (EyeNet). https://www.aao.org/eyenet/article/managing-submacular-hemorrhage. Date Accessed February 4, 2026.

Age-Related Macular Degeneration. EyeWiki. https://eyewiki.org/Age-Related_Macular_Degeneration. Date Accessed February 4, 2026.

Polypoidal Choroidal Vasculopathy. EyeWiki. https://eyewiki.org/Polypoidal_Choroidal_Vasculopathy. Date Accessed February 4, 2026.

Polypoidal Choroidal Vasculopathy. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK567780/. Date Accessed February 4, 2026.